🏥 The "Single Claim" Trap (2026 Reality)
Imagine you have a base health policy of ₹5 Lakhs. Medical inflation in 2026 has driven surgery costs sky-high.
Scenario A (Multiple Small Illnesses): You get Dengue in March (Bill: ₹4 Lakhs). Later, you get Jaundice in September (Bill: ₹4 Lakhs). The "Restoration" benefit refills your limit, and both are paid.
Scenario B (One Big Disaster): You undergo a major heart surgery or cancer treatment. The single bill is ₹15 Lakhs.
Here is where "Restoration" FAILS.
In Scenario B, the restoration benefit pays ZERO extra for that single invoice. It refills the bucket only after the claim is closed, for future use. You are left paying ₹10 Lakhs from your own pocket.
1. Unlimited Restoration (The Refill)
Think of this as refilling a water bottle.
- How it works: If you exhaust your ₹5 Lakhs, the insurer refills it with another ₹5 Lakhs.
- The Catch: It does NOT expand the bottle size. It creates a new limit for a new claim. Even policies that cover "Same Illness" typically treat it as a refill for a subsequent hospitalization, not the current ongoing one. It effectively caps your single-claim capacity at the base sum.
2. Super Top-up (The Extension)
Think of this as buying a massive water tank.
🚀 The Super Top-up Mechanism
You buy a ₹20 Lakh Super Top-up policy with a ₹5 Lakh Aggregate Deductible.
Scenario B (₹15 Lakh Single Bill):
• First ₹5 Lakhs: Paid by your Base Policy (or your pocket).
• Remaining ₹10 Lakhs: Paid by the Super Top-up Policy.
• Your Cost: ₹0.
Benefit: It covers Single Catastrophic Claims perfectly. It works on an "Aggregate" basis, meaning multiple small claims can also trigger it once they cross the ₹5 Lakh threshold total for the year.
3. The Cost Difference (2026 Estimates)
Why not just buy a huge base policy? Premium efficiency.
| Option | Approx Premium (Age 35) |
|---|---|
| Base Policy Only (₹25 Lakhs) | ₹28,000 / year |
| Base (₹5L) + Super Top-up (₹20L) | ₹16,000 / year |
Result: You get the same total coverage for roughly 40% less cost.
🛡️ Chief Editor’s Verdict
Restoration is a feature; Top-up is insurance.
Restoration is often a marketing gimmick useful for minor, frequent hospitalizations. Super Top-up is true financial protection against life-altering surgeries.
Always maintain a modest Base Policy (to cover the deductible and earn No Claim Bonus) and layer it with a massive Super Top-up. This is the smartest, most cost-effective way to structure health insurance in India.
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